Bulimia Nervosa in Adolescents

What is bulimia nervosa?

Bulimia nervosa, usually referred to as bulimia, is defined as uncontrolled episodes of overeating (bingeing). This overeating is usually followed by self-induced vomiting (purging), misuse of laxatives, enemas, or medicines that increase the amount of urine, fasting, or overdoing exercise to control weight. Bingeing, in this situation, is defined as eating much larger amounts of food than would normally be eaten within a short period of time (usually less than 2 hours). Eating binges happen at least twice a week for 3 months. They may happen as often as several times a day.

What causes bulimia?

The cause of bulimia is not known. Cultural ideals and social attitudes toward body appearance are some of the factors that are thought to lead to bulimia. Also, self-evaluation based on body weight and shape, and family problems.

Who is affected by bulimia?

The majority of bulimics are female, adolescent, and from a high socioeconomic group. All westernized industrial countries have reported cases of bulimia. Adolescents who develop bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health problems, like mood disorders or substance abuse. Other mental health problems, like anxiety disorders, or mood disorders, are commonly found in teens with bulimia.

What are the different types of bulimia?

There are 2 types of bulimia aimed at reducing how many calories a person consumes, including the following:

Purging type. This type regularly engages in self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medicines that increase the clearing of the intestines.

Nonpurging type. This type uses other inappropriate behaviors, like fasting or overdoing exercise, rather than regularly engaging in purging.

What are the symptoms of bulimia?

The following are the most common symptoms of bulimia. However, each adolescent may experience signs differently. Symptoms may include:

Usually a normal or low body weight (sees self as overweight)

Repeated episodes of binge eating (quickly eating extra amounts of food in a relatively short period of time; often done secretly), together with fear of not being able to stop eating during the bingeing episodes

Self-induced vomiting (usually in secret)

Excessive exercise or fasting

Strange eating habits or rituals

Inappropriate use of laxatives, diuretics, or other agents to clear the bowels

Irregular or absence of menstruation

Anxiety

Discouragement related to dissatisfaction with themselves and their bodily appearance

Depression

Preoccupation with food, weight, and body shape

Scarring on the back of the fingers from the process of self-induced vomiting

Overachieving behaviors

The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always talk with your adolescent's health care provider for a diagnosis.

How is bulimia diagnosed?

Parents, teachers, coaches, or instructors may be able to identify the child or adolescent with bulimia. Many people with the disorder initially keep their illness hidden. However, a child psychiatrist or a qualified mental health professional usually diagnoses bulimia in children and adolescents. A detailed history of the adolescent's behavior from parents and teachers, clinical observations of the adolescent's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of bulimia in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Bulimia, and the malnutrition that results, can harm nearly every organ system in the body. This is why early diagnosis and treatment is important. Talk with your adolescent's health care provider for more information.

Treatment for bulimia

Specific treatment for bulimia will be decided by your adolescent's health care provider based on:

Your adolescent's age, overall health, and medical history

Extent of your adolescent's symptoms

Your adolescent's tolerance for specific medicines or therapies

Expectations for the course of the condition

Your opinion or preference

Bulimia, in adolescents, is usually treated with a combination of individual therapy, family therapy, behavior modification, and nutritional rehabilitation. Among adults, cognitive behavioral therapy and antidepressant medicines have both been shown to be effective. Treatment should always be based on a total evaluation of the adolescent and family. Individual therapy usually includes both cognitive and behavioral techniques. Medicine (usually antidepressants or antianxiety medicines) may be helpful if the adolescent with bulimia is also anxious or depressed. Since medical complications often happen during the course of rehabilitative treatment, both your adolescent's health care provider and a nutritionist need to be active members of the management team. Parents play an important supportive role in any treatment process.

Prevention of bulimia

Preventive measures to reduce the incidence of bulimia are not known at this time. However, early discovery and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.